|
CHG RADEX HAND MINIMUM 3 VIEWS
|
Professional
|
Both
|
$47.00
|
|
|
Service Code
|
HCPCS 73130
|
| Min. Negotiated Rate |
$5.33 |
| Max. Negotiated Rate |
$325.96 |
| Rate for Payer: Aetna Commercial |
$41.12
|
| Rate for Payer: Aetna Commercial |
$41.12
|
| Rate for Payer: Aetna Commercial |
$41.12
|
| Rate for Payer: Aetna Medicare |
$15.50
|
| Rate for Payer: Aetna Medicare |
$23.50
|
| Rate for Payer: Aetna Medicare |
$48.00
|
| Rate for Payer: BCBS Complete |
$5.60
|
| Rate for Payer: BCBS Complete |
$5.60
|
| Rate for Payer: BCBS Complete |
$5.60
|
| Rate for Payer: BCBS Trust/PPO |
$325.96
|
| Rate for Payer: BCBS Trust/PPO |
$325.96
|
| Rate for Payer: BCBS Trust/PPO |
$325.96
|
| Rate for Payer: BCN Commercial |
$54.24
|
| Rate for Payer: BCN Commercial |
$54.24
|
| Rate for Payer: BCN Commercial |
$54.24
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Meridian Medicaid |
$5.60
|
| Rate for Payer: Meridian Medicaid |
$5.60
|
| Rate for Payer: Meridian Medicaid |
$5.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.83
|
| Rate for Payer: Priority Health Narrow Network |
$12.83
|
| Rate for Payer: Priority Health Narrow Network |
$12.83
|
| Rate for Payer: Priority Health Narrow Network |
$12.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.75
|
| Rate for Payer: UHC Exchange |
$32.75
|
| Rate for Payer: UHC Exchange |
$32.75
|
| Rate for Payer: UHC Exchange |
$32.75
|
| Rate for Payer: UHCCP Medicaid |
$5.33
|
| Rate for Payer: UHCCP Medicaid |
$5.33
|
| Rate for Payer: UHCCP Medicaid |
$5.33
|
|
|
CHG RADEX HIPS BILATERAL WITH PELVIS 2 VIEWS
|
Professional
|
Both
|
$23.00
|
|
|
Service Code
|
HCPCS 73521
|
| Min. Negotiated Rate |
$6.82 |
| Max. Negotiated Rate |
$355.02 |
| Rate for Payer: Aetna Commercial |
$46.65
|
| Rate for Payer: Aetna Commercial |
$46.65
|
| Rate for Payer: Aetna Medicare |
$11.50
|
| Rate for Payer: Aetna Medicare |
$38.50
|
| Rate for Payer: BCBS Complete |
$7.16
|
| Rate for Payer: BCBS Complete |
$7.16
|
| Rate for Payer: BCBS Trust/PPO |
$355.02
|
| Rate for Payer: BCBS Trust/PPO |
$355.02
|
| Rate for Payer: BCN Commercial |
$60.60
|
| Rate for Payer: BCN Commercial |
$60.60
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Meridian Medicaid |
$7.16
|
| Rate for Payer: Meridian Medicaid |
$7.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.42
|
| Rate for Payer: Priority Health Narrow Network |
$16.42
|
| Rate for Payer: Priority Health Narrow Network |
$16.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$43.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$43.75
|
| Rate for Payer: UHC Exchange |
$43.75
|
| Rate for Payer: UHC Exchange |
$43.75
|
| Rate for Payer: UHCCP Medicaid |
$6.82
|
| Rate for Payer: UHCCP Medicaid |
$6.82
|
|
|
CHG RADEX HIPS BILATERAL WITH PELVIS 3-4 VIEWS
|
Professional
|
Both
|
$63.00
|
|
|
Service Code
|
HCPCS 73522
|
| Min. Negotiated Rate |
$8.95 |
| Max. Negotiated Rate |
$358.19 |
| Rate for Payer: Aetna Commercial |
$60.64
|
| Rate for Payer: Aetna Commercial |
$60.64
|
| Rate for Payer: Aetna Commercial |
$60.64
|
| Rate for Payer: Aetna Medicare |
$31.50
|
| Rate for Payer: Aetna Medicare |
$58.50
|
| Rate for Payer: Aetna Medicare |
$15.50
|
| Rate for Payer: BCBS Complete |
$9.40
|
| Rate for Payer: BCBS Complete |
$9.40
|
| Rate for Payer: BCBS Complete |
$9.40
|
| Rate for Payer: BCBS Trust/PPO |
$358.19
|
| Rate for Payer: BCBS Trust/PPO |
$358.19
|
| Rate for Payer: BCBS Trust/PPO |
$358.19
|
| Rate for Payer: BCN Commercial |
$78.68
|
| Rate for Payer: BCN Commercial |
$78.68
|
| Rate for Payer: BCN Commercial |
$78.68
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Meridian Medicaid |
$9.40
|
| Rate for Payer: Meridian Medicaid |
$9.40
|
| Rate for Payer: Meridian Medicaid |
$9.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.56
|
| Rate for Payer: Priority Health Narrow Network |
$21.56
|
| Rate for Payer: Priority Health Narrow Network |
$21.56
|
| Rate for Payer: Priority Health Narrow Network |
$21.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.05
|
| Rate for Payer: UHC Exchange |
$54.05
|
| Rate for Payer: UHC Exchange |
$54.05
|
| Rate for Payer: UHC Exchange |
$54.05
|
| Rate for Payer: UHCCP Medicaid |
$8.95
|
| Rate for Payer: UHCCP Medicaid |
$8.95
|
| Rate for Payer: UHCCP Medicaid |
$8.95
|
|
|
CHG RADEX HIPS BILATERAL WITH PELVIS MINIMUM 5 VIEWS
|
Professional
|
Both
|
$114.00
|
|
|
Service Code
|
HCPCS 73523
|
| Min. Negotiated Rate |
$9.59 |
| Max. Negotiated Rate |
$2,539.54 |
| Rate for Payer: Aetna Commercial |
$69.49
|
| Rate for Payer: Aetna Commercial |
$69.49
|
| Rate for Payer: Aetna Medicare |
$57.00
|
| Rate for Payer: Aetna Medicare |
$13.00
|
| Rate for Payer: BCBS Complete |
$10.07
|
| Rate for Payer: BCBS Complete |
$10.07
|
| Rate for Payer: BCBS Trust/PPO |
$2,539.54
|
| Rate for Payer: BCBS Trust/PPO |
$2,539.54
|
| Rate for Payer: BCN Commercial |
$90.89
|
| Rate for Payer: BCN Commercial |
$90.89
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Meridian Medicaid |
$10.07
|
| Rate for Payer: Meridian Medicaid |
$10.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23.10
|
| Rate for Payer: Priority Health Narrow Network |
$23.10
|
| Rate for Payer: Priority Health Narrow Network |
$23.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$62.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$62.67
|
| Rate for Payer: UHC Exchange |
$62.67
|
| Rate for Payer: UHC Exchange |
$62.67
|
| Rate for Payer: UHCCP Medicaid |
$9.59
|
| Rate for Payer: UHCCP Medicaid |
$9.59
|
|
|
CHG RADEX HIP UNILATERAL WITH PELVIS 1 VIEW
|
Professional
|
Both
|
$19.00
|
|
|
Service Code
|
HCPCS 73501
|
| Min. Negotiated Rate |
$5.75 |
| Max. Negotiated Rate |
$471.24 |
| Rate for Payer: Aetna Commercial |
$36.58
|
| Rate for Payer: Aetna Commercial |
$36.58
|
| Rate for Payer: Aetna Medicare |
$9.50
|
| Rate for Payer: Aetna Medicare |
$28.50
|
| Rate for Payer: BCBS Complete |
$6.04
|
| Rate for Payer: BCBS Complete |
$6.04
|
| Rate for Payer: BCBS Trust/PPO |
$471.24
|
| Rate for Payer: BCBS Trust/PPO |
$471.24
|
| Rate for Payer: BCN Commercial |
$48.38
|
| Rate for Payer: BCN Commercial |
$48.38
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cash Price |
$15.20
|
| Rate for Payer: Cash Price |
$15.20
|
| Rate for Payer: Meridian Medicaid |
$6.04
|
| Rate for Payer: Meridian Medicaid |
$6.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.86
|
| Rate for Payer: Priority Health Narrow Network |
$13.86
|
| Rate for Payer: Priority Health Narrow Network |
$13.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.76
|
| Rate for Payer: UHC Exchange |
$32.76
|
| Rate for Payer: UHC Exchange |
$32.76
|
| Rate for Payer: UHCCP Medicaid |
$5.75
|
| Rate for Payer: UHCCP Medicaid |
$5.75
|
|
|
CHG RADEX HIP UNILATERAL WITH PELVIS 2-3 VIEWS
|
Professional
|
Both
|
$80.00
|
|
|
Service Code
|
HCPCS 73502
|
| Min. Negotiated Rate |
$6.82 |
| Max. Negotiated Rate |
$267.32 |
| Rate for Payer: Aetna Commercial |
$52.75
|
| Rate for Payer: Aetna Commercial |
$52.75
|
| Rate for Payer: Aetna Medicare |
$11.00
|
| Rate for Payer: Aetna Medicare |
$40.00
|
| Rate for Payer: BCBS Complete |
$7.16
|
| Rate for Payer: BCBS Complete |
$7.16
|
| Rate for Payer: BCBS Trust/PPO |
$267.32
|
| Rate for Payer: BCBS Trust/PPO |
$267.32
|
| Rate for Payer: BCN Commercial |
$68.90
|
| Rate for Payer: BCN Commercial |
$68.90
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Cash Price |
$17.60
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Cash Price |
$17.60
|
| Rate for Payer: Meridian Medicaid |
$7.16
|
| Rate for Payer: Meridian Medicaid |
$7.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.42
|
| Rate for Payer: Priority Health Narrow Network |
$16.42
|
| Rate for Payer: Priority Health Narrow Network |
$16.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.69
|
| Rate for Payer: UHC Exchange |
$45.69
|
| Rate for Payer: UHC Exchange |
$45.69
|
| Rate for Payer: UHCCP Medicaid |
$6.82
|
| Rate for Payer: UHCCP Medicaid |
$6.82
|
|
|
CHG RADEX HIP UNILATERAL WITH PELVIS MINIMUM 4 VIEWS
|
Professional
|
Both
|
$124.00
|
|
|
Service Code
|
HCPCS 73503
|
| Min. Negotiated Rate |
$8.52 |
| Max. Negotiated Rate |
$86.99 |
| Rate for Payer: Aetna Commercial |
$66.29
|
| Rate for Payer: Aetna Commercial |
$66.29
|
| Rate for Payer: Aetna Medicare |
$14.00
|
| Rate for Payer: Aetna Medicare |
$62.00
|
| Rate for Payer: BCBS Complete |
$8.95
|
| Rate for Payer: BCBS Complete |
$8.95
|
| Rate for Payer: BCN Commercial |
$86.99
|
| Rate for Payer: BCN Commercial |
$86.99
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: Cash Price |
$99.20
|
| Rate for Payer: Cash Price |
$99.20
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: Meridian Medicaid |
$8.95
|
| Rate for Payer: Meridian Medicaid |
$8.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.01
|
| Rate for Payer: Priority Health Narrow Network |
$20.01
|
| Rate for Payer: Priority Health Narrow Network |
$20.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$57.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$57.15
|
| Rate for Payer: UHC Exchange |
$57.15
|
| Rate for Payer: UHC Exchange |
$57.15
|
| Rate for Payer: UHCCP Medicaid |
$8.52
|
| Rate for Payer: UHCCP Medicaid |
$8.52
|
|
|
CHG RADEX HUMERUS MINIMUM 2 VIEWS
|
Professional
|
Both
|
$33.00
|
|
|
Service Code
|
HCPCS 73060
|
| Min. Negotiated Rate |
$4.90 |
| Max. Negotiated Rate |
$222.41 |
| Rate for Payer: Aetna Commercial |
$36.51
|
| Rate for Payer: Aetna Commercial |
$36.51
|
| Rate for Payer: Aetna Commercial |
$36.51
|
| Rate for Payer: Aetna Medicare |
$52.50
|
| Rate for Payer: Aetna Medicare |
$16.50
|
| Rate for Payer: Aetna Medicare |
$20.00
|
| Rate for Payer: BCBS Complete |
$5.14
|
| Rate for Payer: BCBS Complete |
$5.14
|
| Rate for Payer: BCBS Complete |
$5.14
|
| Rate for Payer: BCBS Trust/PPO |
$222.41
|
| Rate for Payer: BCBS Trust/PPO |
$222.41
|
| Rate for Payer: BCBS Trust/PPO |
$222.41
|
| Rate for Payer: BCN Commercial |
$47.41
|
| Rate for Payer: BCN Commercial |
$47.41
|
| Rate for Payer: BCN Commercial |
$47.41
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Meridian Medicaid |
$5.14
|
| Rate for Payer: Meridian Medicaid |
$5.14
|
| Rate for Payer: Meridian Medicaid |
$5.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.81
|
| Rate for Payer: Priority Health Narrow Network |
$11.81
|
| Rate for Payer: Priority Health Narrow Network |
$11.81
|
| Rate for Payer: Priority Health Narrow Network |
$11.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.40
|
| Rate for Payer: UHC Exchange |
$30.40
|
| Rate for Payer: UHC Exchange |
$30.40
|
| Rate for Payer: UHC Exchange |
$30.40
|
| Rate for Payer: UHCCP Medicaid |
$4.90
|
| Rate for Payer: UHCCP Medicaid |
$4.90
|
| Rate for Payer: UHCCP Medicaid |
$4.90
|
|
|
CHG RADEX NASAL BONES COMPLETE MINIMUM 3 VIEWS
|
Professional
|
Both
|
$49.00
|
|
|
Service Code
|
HCPCS 70160
|
| Min. Negotiated Rate |
$5.33 |
| Max. Negotiated Rate |
$59.17 |
| Rate for Payer: Aetna Commercial |
$43.03
|
| Rate for Payer: Aetna Commercial |
$43.03
|
| Rate for Payer: Aetna Medicare |
$28.00
|
| Rate for Payer: Aetna Medicare |
$24.50
|
| Rate for Payer: BCBS Complete |
$5.60
|
| Rate for Payer: BCBS Complete |
$5.60
|
| Rate for Payer: BCBS Trust/PPO |
$59.17
|
| Rate for Payer: BCBS Trust/PPO |
$59.17
|
| Rate for Payer: BCN Commercial |
$56.19
|
| Rate for Payer: BCN Commercial |
$56.19
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Meridian Medicaid |
$5.60
|
| Rate for Payer: Meridian Medicaid |
$5.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.32
|
| Rate for Payer: Priority Health Narrow Network |
$12.32
|
| Rate for Payer: Priority Health Narrow Network |
$12.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33.91
|
| Rate for Payer: UHC Exchange |
$33.91
|
| Rate for Payer: UHC Exchange |
$33.91
|
| Rate for Payer: UHCCP Medicaid |
$5.33
|
| Rate for Payer: UHCCP Medicaid |
$5.33
|
|
|
CHG RADEX OPTIC FORAMINA
|
Professional
|
Both
|
$64.00
|
|
|
Service Code
|
HCPCS 70190
|
| Min. Negotiated Rate |
$6.82 |
| Max. Negotiated Rate |
$79.77 |
| Rate for Payer: Aetna Commercial |
$43.94
|
| Rate for Payer: Aetna Medicare |
$32.00
|
| Rate for Payer: BCBS Complete |
$7.16
|
| Rate for Payer: BCBS Trust/PPO |
$79.77
|
| Rate for Payer: BCN Commercial |
$55.22
|
| Rate for Payer: Cash Price |
$51.20
|
| Rate for Payer: Cash Price |
$51.20
|
| Rate for Payer: Meridian Medicaid |
$7.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.42
|
| Rate for Payer: Priority Health Narrow Network |
$16.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.10
|
| Rate for Payer: UHC Exchange |
$37.10
|
| Rate for Payer: UHCCP Medicaid |
$6.82
|
|
|
CHG RADEX ORBITS COMPLETE MINIMUM 4 VIEWS
|
Professional
|
Both
|
$57.00
|
|
|
Service Code
|
HCPCS 70200
|
| Min. Negotiated Rate |
$8.52 |
| Max. Negotiated Rate |
$120.45 |
| Rate for Payer: Aetna Commercial |
$54.89
|
| Rate for Payer: Aetna Medicare |
$28.50
|
| Rate for Payer: BCBS Complete |
$8.95
|
| Rate for Payer: BCBS Trust/PPO |
$120.45
|
| Rate for Payer: BCN Commercial |
$70.37
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Meridian Medicaid |
$8.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.54
|
| Rate for Payer: Priority Health Narrow Network |
$20.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.79
|
| Rate for Payer: UHC Exchange |
$45.79
|
| Rate for Payer: UHCCP Medicaid |
$8.52
|
|
|
CHG RADEX RIBS BILATERAL 3 VIEWS
|
Professional
|
Both
|
$53.00
|
|
|
Service Code
|
HCPCS 71110
|
| Min. Negotiated Rate |
$8.73 |
| Max. Negotiated Rate |
$3,046.18 |
| Rate for Payer: Aetna Commercial |
$49.96
|
| Rate for Payer: Aetna Commercial |
$49.96
|
| Rate for Payer: Aetna Medicare |
$26.50
|
| Rate for Payer: Aetna Medicare |
$55.00
|
| Rate for Payer: BCBS Complete |
$9.17
|
| Rate for Payer: BCBS Complete |
$9.17
|
| Rate for Payer: BCBS Trust/PPO |
$3,046.18
|
| Rate for Payer: BCBS Trust/PPO |
$3,046.18
|
| Rate for Payer: BCN Commercial |
$64.51
|
| Rate for Payer: BCN Commercial |
$64.51
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cash Price |
$42.40
|
| Rate for Payer: Cash Price |
$42.40
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Meridian Medicaid |
$9.17
|
| Rate for Payer: Meridian Medicaid |
$9.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.05
|
| Rate for Payer: Priority Health Narrow Network |
$21.05
|
| Rate for Payer: Priority Health Narrow Network |
$21.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.26
|
| Rate for Payer: UHC Exchange |
$42.26
|
| Rate for Payer: UHC Exchange |
$42.26
|
| Rate for Payer: UHCCP Medicaid |
$8.73
|
| Rate for Payer: UHCCP Medicaid |
$8.73
|
|
|
CHG RADEX RIBS BI W/POSTEROANT CH MINIMUM 4 VIEWS
|
Professional
|
Both
|
$33.00
|
|
|
Service Code
|
HCPCS 71111
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$2,693.80 |
| Rate for Payer: Aetna Commercial |
$59.61
|
| Rate for Payer: Aetna Commercial |
$59.61
|
| Rate for Payer: Aetna Medicare |
$36.00
|
| Rate for Payer: Aetna Medicare |
$16.50
|
| Rate for Payer: BCBS Complete |
$10.29
|
| Rate for Payer: BCBS Complete |
$10.29
|
| Rate for Payer: BCBS Trust/PPO |
$2,693.80
|
| Rate for Payer: BCBS Trust/PPO |
$2,693.80
|
| Rate for Payer: BCN Commercial |
$77.21
|
| Rate for Payer: BCN Commercial |
$77.21
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Meridian Medicaid |
$10.29
|
| Rate for Payer: Meridian Medicaid |
$10.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23.61
|
| Rate for Payer: Priority Health Narrow Network |
$23.61
|
| Rate for Payer: Priority Health Narrow Network |
$23.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.44
|
| Rate for Payer: UHC Exchange |
$54.44
|
| Rate for Payer: UHC Exchange |
$54.44
|
| Rate for Payer: UHCCP Medicaid |
$9.80
|
| Rate for Payer: UHCCP Medicaid |
$9.80
|
|
|
CHG RADEX RIBS UNILATERAL 2 VIEWS
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 71100
|
| Min. Negotiated Rate |
$6.82 |
| Max. Negotiated Rate |
$3,087.39 |
| Rate for Payer: Aetna Commercial |
$41.69
|
| Rate for Payer: Aetna Medicare |
$25.00
|
| Rate for Payer: BCBS Complete |
$7.16
|
| Rate for Payer: BCBS Trust/PPO |
$3,087.39
|
| Rate for Payer: BCN Commercial |
$54.24
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Meridian Medicaid |
$7.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.91
|
| Rate for Payer: Priority Health Narrow Network |
$15.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.39
|
| Rate for Payer: UHC Exchange |
$34.39
|
| Rate for Payer: UHCCP Medicaid |
$6.82
|
|
|
CHG RADEX RIBS UNI W/POSTEROANT CH MINIMUM 3 VIEWS
|
Professional
|
Both
|
$52.00
|
|
|
Service Code
|
HCPCS 71101
|
| Min. Negotiated Rate |
$8.09 |
| Max. Negotiated Rate |
$2,607.16 |
| Rate for Payer: Aetna Commercial |
$47.98
|
| Rate for Payer: Aetna Commercial |
$47.98
|
| Rate for Payer: Aetna Medicare |
$26.00
|
| Rate for Payer: Aetna Medicare |
$30.50
|
| Rate for Payer: BCBS Complete |
$8.49
|
| Rate for Payer: BCBS Complete |
$8.49
|
| Rate for Payer: BCBS Trust/PPO |
$2,607.16
|
| Rate for Payer: BCBS Trust/PPO |
$2,607.16
|
| Rate for Payer: BCN Commercial |
$62.06
|
| Rate for Payer: BCN Commercial |
$62.06
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Meridian Medicaid |
$8.49
|
| Rate for Payer: Meridian Medicaid |
$8.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.51
|
| Rate for Payer: Priority Health Narrow Network |
$19.51
|
| Rate for Payer: Priority Health Narrow Network |
$19.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$41.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$41.10
|
| Rate for Payer: UHC Exchange |
$41.10
|
| Rate for Payer: UHC Exchange |
$41.10
|
| Rate for Payer: UHCCP Medicaid |
$8.09
|
| Rate for Payer: UHCCP Medicaid |
$8.09
|
|
|
CHG RADEX SACRUM & COCCYX MINIMUM 2 VIEWS
|
Professional
|
Both
|
$43.00
|
|
|
Service Code
|
HCPCS 72220
|
| Min. Negotiated Rate |
$5.33 |
| Max. Negotiated Rate |
$2,093.12 |
| Rate for Payer: Aetna Commercial |
$36.55
|
| Rate for Payer: Aetna Commercial |
$36.55
|
| Rate for Payer: Aetna Commercial |
$36.55
|
| Rate for Payer: Aetna Medicare |
$21.50
|
| Rate for Payer: Aetna Medicare |
$63.00
|
| Rate for Payer: Aetna Medicare |
$20.00
|
| Rate for Payer: BCBS Complete |
$5.60
|
| Rate for Payer: BCBS Complete |
$5.60
|
| Rate for Payer: BCBS Complete |
$5.60
|
| Rate for Payer: BCBS Trust/PPO |
$2,093.12
|
| Rate for Payer: BCBS Trust/PPO |
$2,093.12
|
| Rate for Payer: BCBS Trust/PPO |
$2,093.12
|
| Rate for Payer: BCN Commercial |
$47.89
|
| Rate for Payer: BCN Commercial |
$47.89
|
| Rate for Payer: BCN Commercial |
$47.89
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Meridian Medicaid |
$5.60
|
| Rate for Payer: Meridian Medicaid |
$5.60
|
| Rate for Payer: Meridian Medicaid |
$5.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.83
|
| Rate for Payer: Priority Health Narrow Network |
$12.83
|
| Rate for Payer: Priority Health Narrow Network |
$12.83
|
| Rate for Payer: Priority Health Narrow Network |
$12.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.40
|
| Rate for Payer: UHC Exchange |
$30.40
|
| Rate for Payer: UHC Exchange |
$30.40
|
| Rate for Payer: UHC Exchange |
$30.40
|
| Rate for Payer: UHCCP Medicaid |
$5.33
|
| Rate for Payer: UHCCP Medicaid |
$5.33
|
| Rate for Payer: UHCCP Medicaid |
$5.33
|
|
|
CHG RADEX SCAPULA COMPLETE
|
Professional
|
Both
|
$36.00
|
|
|
Service Code
|
HCPCS 73010
|
| Min. Negotiated Rate |
$5.54 |
| Max. Negotiated Rate |
$2,600.29 |
| Rate for Payer: Aetna Commercial |
$27.01
|
| Rate for Payer: Aetna Commercial |
$27.01
|
| Rate for Payer: Aetna Commercial |
$27.01
|
| Rate for Payer: Aetna Medicare |
$53.50
|
| Rate for Payer: Aetna Medicare |
$18.00
|
| Rate for Payer: Aetna Medicare |
$22.00
|
| Rate for Payer: BCBS Complete |
$5.82
|
| Rate for Payer: BCBS Complete |
$5.82
|
| Rate for Payer: BCBS Complete |
$5.82
|
| Rate for Payer: BCBS Trust/PPO |
$2,600.29
|
| Rate for Payer: BCBS Trust/PPO |
$2,600.29
|
| Rate for Payer: BCBS Trust/PPO |
$2,600.29
|
| Rate for Payer: BCN Commercial |
$34.70
|
| Rate for Payer: BCN Commercial |
$34.70
|
| Rate for Payer: BCN Commercial |
$34.70
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cash Price |
$85.60
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$85.60
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Meridian Medicaid |
$5.82
|
| Rate for Payer: Meridian Medicaid |
$5.82
|
| Rate for Payer: Meridian Medicaid |
$5.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.34
|
| Rate for Payer: Priority Health Narrow Network |
$13.34
|
| Rate for Payer: Priority Health Narrow Network |
$13.34
|
| Rate for Payer: Priority Health Narrow Network |
$13.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.84
|
| Rate for Payer: UHC Exchange |
$30.84
|
| Rate for Payer: UHC Exchange |
$30.84
|
| Rate for Payer: UHC Exchange |
$30.84
|
| Rate for Payer: UHCCP Medicaid |
$5.54
|
| Rate for Payer: UHCCP Medicaid |
$5.54
|
| Rate for Payer: UHCCP Medicaid |
$5.54
|
|
|
CHG RADEX SHOULDER 1 VIEW
|
Professional
|
Both
|
$27.00
|
|
|
Service Code
|
HCPCS 73020
|
| Min. Negotiated Rate |
$4.69 |
| Max. Negotiated Rate |
$940.90 |
| Rate for Payer: Aetna Commercial |
$24.65
|
| Rate for Payer: Aetna Commercial |
$24.65
|
| Rate for Payer: Aetna Medicare |
$13.50
|
| Rate for Payer: Aetna Medicare |
$40.50
|
| Rate for Payer: BCBS Complete |
$4.92
|
| Rate for Payer: BCBS Complete |
$4.92
|
| Rate for Payer: BCBS Trust/PPO |
$940.90
|
| Rate for Payer: BCBS Trust/PPO |
$940.90
|
| Rate for Payer: BCN Commercial |
$31.76
|
| Rate for Payer: BCN Commercial |
$31.76
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Meridian Medicaid |
$4.92
|
| Rate for Payer: Meridian Medicaid |
$4.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.29
|
| Rate for Payer: Priority Health Narrow Network |
$11.29
|
| Rate for Payer: Priority Health Narrow Network |
$11.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.92
|
| Rate for Payer: UHC Exchange |
$24.92
|
| Rate for Payer: UHC Exchange |
$24.92
|
| Rate for Payer: UHCCP Medicaid |
$4.69
|
| Rate for Payer: UHCCP Medicaid |
$4.69
|
|
|
CHG RADEX SHOULDER COMPLETE MINIMUM 2 VIEWS
|
Professional
|
Both
|
$41.00
|
|
|
Service Code
|
HCPCS 73030
|
| Min. Negotiated Rate |
$5.75 |
| Max. Negotiated Rate |
$2,232.07 |
| Rate for Payer: Aetna Commercial |
$38.87
|
| Rate for Payer: Aetna Commercial |
$38.87
|
| Rate for Payer: Aetna Commercial |
$38.87
|
| Rate for Payer: Aetna Medicare |
$20.50
|
| Rate for Payer: Aetna Medicare |
$57.00
|
| Rate for Payer: Aetna Medicare |
$18.00
|
| Rate for Payer: BCBS Complete |
$6.04
|
| Rate for Payer: BCBS Complete |
$6.04
|
| Rate for Payer: BCBS Complete |
$6.04
|
| Rate for Payer: BCBS Trust/PPO |
$2,232.07
|
| Rate for Payer: BCBS Trust/PPO |
$2,232.07
|
| Rate for Payer: BCBS Trust/PPO |
$2,232.07
|
| Rate for Payer: BCN Commercial |
$50.82
|
| Rate for Payer: BCN Commercial |
$50.82
|
| Rate for Payer: BCN Commercial |
$50.82
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Meridian Medicaid |
$6.04
|
| Rate for Payer: Meridian Medicaid |
$6.04
|
| Rate for Payer: Meridian Medicaid |
$6.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.86
|
| Rate for Payer: Priority Health Narrow Network |
$13.86
|
| Rate for Payer: Priority Health Narrow Network |
$13.86
|
| Rate for Payer: Priority Health Narrow Network |
$13.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.64
|
| Rate for Payer: UHC Exchange |
$31.64
|
| Rate for Payer: UHC Exchange |
$31.64
|
| Rate for Payer: UHC Exchange |
$31.64
|
| Rate for Payer: UHCCP Medicaid |
$5.75
|
| Rate for Payer: UHCCP Medicaid |
$5.75
|
| Rate for Payer: UHCCP Medicaid |
$5.75
|
|
|
CHG RADEX SINUSES PARANASAL <3 VIEWS
|
Professional
|
Both
|
$18.00
|
|
|
Service Code
|
HCPCS 70210
|
| Min. Negotiated Rate |
$5.33 |
| Max. Negotiated Rate |
$163.24 |
| Rate for Payer: Aetna Commercial |
$36.55
|
| Rate for Payer: Aetna Commercial |
$36.55
|
| Rate for Payer: Aetna Medicare |
$9.00
|
| Rate for Payer: Aetna Medicare |
$21.50
|
| Rate for Payer: BCBS Complete |
$5.60
|
| Rate for Payer: BCBS Complete |
$5.60
|
| Rate for Payer: BCBS Trust/PPO |
$163.24
|
| Rate for Payer: BCBS Trust/PPO |
$163.24
|
| Rate for Payer: BCN Commercial |
$47.41
|
| Rate for Payer: BCN Commercial |
$47.41
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Meridian Medicaid |
$5.60
|
| Rate for Payer: Meridian Medicaid |
$5.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.83
|
| Rate for Payer: Priority Health Narrow Network |
$12.83
|
| Rate for Payer: Priority Health Narrow Network |
$12.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.57
|
| Rate for Payer: UHC Exchange |
$31.57
|
| Rate for Payer: UHC Exchange |
$31.57
|
| Rate for Payer: UHCCP Medicaid |
$5.33
|
| Rate for Payer: UHCCP Medicaid |
$5.33
|
|
|
CHG RADEX SINUSES PARANASAL COMPL MINIMUM 3 VIEWS
|
Professional
|
Both
|
$51.00
|
|
|
Service Code
|
HCPCS 70220
|
| Min. Negotiated Rate |
$6.60 |
| Max. Negotiated Rate |
$57.58 |
| Rate for Payer: Aetna Commercial |
$42.84
|
| Rate for Payer: Aetna Commercial |
$42.84
|
| Rate for Payer: Aetna Medicare |
$25.50
|
| Rate for Payer: Aetna Medicare |
$33.00
|
| Rate for Payer: BCBS Complete |
$6.93
|
| Rate for Payer: BCBS Complete |
$6.93
|
| Rate for Payer: BCBS Trust/PPO |
$57.58
|
| Rate for Payer: BCBS Trust/PPO |
$57.58
|
| Rate for Payer: BCN Commercial |
$55.22
|
| Rate for Payer: BCN Commercial |
$55.22
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Meridian Medicaid |
$6.93
|
| Rate for Payer: Meridian Medicaid |
$6.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.91
|
| Rate for Payer: Priority Health Narrow Network |
$15.91
|
| Rate for Payer: Priority Health Narrow Network |
$15.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$40.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$40.68
|
| Rate for Payer: UHC Exchange |
$40.68
|
| Rate for Payer: UHC Exchange |
$40.68
|
| Rate for Payer: UHCCP Medicaid |
$6.60
|
| Rate for Payer: UHCCP Medicaid |
$6.60
|
|
|
CHG RADEX SPINE 1 VIEW SPECIFY LEVEL
|
Professional
|
Both
|
$27.00
|
|
|
Service Code
|
HCPCS 72020
|
| Min. Negotiated Rate |
$4.90 |
| Max. Negotiated Rate |
$527.77 |
| Rate for Payer: Aetna Commercial |
$28.12
|
| Rate for Payer: Aetna Commercial |
$28.12
|
| Rate for Payer: Aetna Medicare |
$13.50
|
| Rate for Payer: Aetna Medicare |
$15.50
|
| Rate for Payer: BCBS Complete |
$5.14
|
| Rate for Payer: BCBS Complete |
$5.14
|
| Rate for Payer: BCBS Trust/PPO |
$527.77
|
| Rate for Payer: BCBS Trust/PPO |
$527.77
|
| Rate for Payer: BCN Commercial |
$36.16
|
| Rate for Payer: BCN Commercial |
$36.16
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Meridian Medicaid |
$5.14
|
| Rate for Payer: Meridian Medicaid |
$5.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.81
|
| Rate for Payer: Priority Health Narrow Network |
$11.81
|
| Rate for Payer: Priority Health Narrow Network |
$11.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.30
|
| Rate for Payer: UHC Exchange |
$25.30
|
| Rate for Payer: UHC Exchange |
$25.30
|
| Rate for Payer: UHCCP Medicaid |
$4.90
|
| Rate for Payer: UHCCP Medicaid |
$4.90
|
|
|
CHG RADEX SPINE CERVICAL 2 OR 3 VIEWS
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 72040
|
| Min. Negotiated Rate |
$6.82 |
| Max. Negotiated Rate |
$1,719.09 |
| Rate for Payer: Aetna Commercial |
$44.74
|
| Rate for Payer: Aetna Commercial |
$44.74
|
| Rate for Payer: Aetna Commercial |
$44.74
|
| Rate for Payer: Aetna Medicare |
$25.00
|
| Rate for Payer: Aetna Medicare |
$51.00
|
| Rate for Payer: Aetna Medicare |
$19.00
|
| Rate for Payer: BCBS Complete |
$7.16
|
| Rate for Payer: BCBS Complete |
$7.16
|
| Rate for Payer: BCBS Complete |
$7.16
|
| Rate for Payer: BCBS Trust/PPO |
$1,719.09
|
| Rate for Payer: BCBS Trust/PPO |
$1,719.09
|
| Rate for Payer: BCBS Trust/PPO |
$1,719.09
|
| Rate for Payer: BCN Commercial |
$58.15
|
| Rate for Payer: BCN Commercial |
$58.15
|
| Rate for Payer: BCN Commercial |
$58.15
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cash Price |
$30.40
|
| Rate for Payer: Cash Price |
$30.40
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Meridian Medicaid |
$7.16
|
| Rate for Payer: Meridian Medicaid |
$7.16
|
| Rate for Payer: Meridian Medicaid |
$7.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.42
|
| Rate for Payer: Priority Health Narrow Network |
$16.42
|
| Rate for Payer: Priority Health Narrow Network |
$16.42
|
| Rate for Payer: Priority Health Narrow Network |
$16.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$39.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$39.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$39.50
|
| Rate for Payer: UHC Exchange |
$39.50
|
| Rate for Payer: UHC Exchange |
$39.50
|
| Rate for Payer: UHC Exchange |
$39.50
|
| Rate for Payer: UHCCP Medicaid |
$6.82
|
| Rate for Payer: UHCCP Medicaid |
$6.82
|
| Rate for Payer: UHCCP Medicaid |
$6.82
|
|
|
CHG RADEX SPINE CERVICAL 4 OR 5 VIEWS
|
Professional
|
Both
|
$52.00
|
|
|
Service Code
|
HCPCS 72050
|
| Min. Negotiated Rate |
$8.31 |
| Max. Negotiated Rate |
$1,535.24 |
| Rate for Payer: Aetna Commercial |
$59.81
|
| Rate for Payer: Aetna Commercial |
$59.81
|
| Rate for Payer: Aetna Commercial |
$59.81
|
| Rate for Payer: Aetna Medicare |
$71.50
|
| Rate for Payer: Aetna Medicare |
$26.00
|
| Rate for Payer: Aetna Medicare |
$33.00
|
| Rate for Payer: BCBS Complete |
$8.73
|
| Rate for Payer: BCBS Complete |
$8.73
|
| Rate for Payer: BCBS Complete |
$8.73
|
| Rate for Payer: BCBS Trust/PPO |
$1,535.24
|
| Rate for Payer: BCBS Trust/PPO |
$1,535.24
|
| Rate for Payer: BCBS Trust/PPO |
$1,535.24
|
| Rate for Payer: BCN Commercial |
$78.19
|
| Rate for Payer: BCN Commercial |
$78.19
|
| Rate for Payer: BCN Commercial |
$78.19
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Cash Price |
$114.40
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Cash Price |
$114.40
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Meridian Medicaid |
$8.73
|
| Rate for Payer: Meridian Medicaid |
$8.73
|
| Rate for Payer: Meridian Medicaid |
$8.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.51
|
| Rate for Payer: Priority Health Narrow Network |
$19.51
|
| Rate for Payer: Priority Health Narrow Network |
$19.51
|
| Rate for Payer: Priority Health Narrow Network |
$19.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.86
|
| Rate for Payer: UHC Exchange |
$54.86
|
| Rate for Payer: UHC Exchange |
$54.86
|
| Rate for Payer: UHC Exchange |
$54.86
|
| Rate for Payer: UHCCP Medicaid |
$8.31
|
| Rate for Payer: UHCCP Medicaid |
$8.31
|
| Rate for Payer: UHCCP Medicaid |
$8.31
|
|
|
CHG RADEX SPINE CERVICAL 6 OR MORE VIEWS
|
Professional
|
Both
|
$88.00
|
|
|
Service Code
|
HCPCS 72052
|
| Min. Negotiated Rate |
$9.16 |
| Max. Negotiated Rate |
$1,477.13 |
| Rate for Payer: Aetna Commercial |
$70.22
|
| Rate for Payer: Aetna Commercial |
$70.22
|
| Rate for Payer: Aetna Medicare |
$44.00
|
| Rate for Payer: Aetna Medicare |
$46.00
|
| Rate for Payer: BCBS Complete |
$9.62
|
| Rate for Payer: BCBS Complete |
$9.62
|
| Rate for Payer: BCBS Trust/PPO |
$1,477.13
|
| Rate for Payer: BCBS Trust/PPO |
$1,477.13
|
| Rate for Payer: BCN Commercial |
$91.38
|
| Rate for Payer: BCN Commercial |
$91.38
|
| Rate for Payer: Cash Price |
$70.40
|
| Rate for Payer: Cash Price |
$73.60
|
| Rate for Payer: Cash Price |
$70.40
|
| Rate for Payer: Cash Price |
$73.60
|
| Rate for Payer: Meridian Medicaid |
$9.62
|
| Rate for Payer: Meridian Medicaid |
$9.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.06
|
| Rate for Payer: Priority Health Narrow Network |
$22.06
|
| Rate for Payer: Priority Health Narrow Network |
$22.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$68.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$68.60
|
| Rate for Payer: UHC Exchange |
$68.60
|
| Rate for Payer: UHC Exchange |
$68.60
|
| Rate for Payer: UHCCP Medicaid |
$9.16
|
| Rate for Payer: UHCCP Medicaid |
$9.16
|
|
